Bridging the Divide: Interoperability and the Future of Payer-Provider Collaboration
In this episode of The Dish on Health IT, Host Tony Schueth, CEO of Point-of-Care Partners (POCP), and Co-host, Kendra Obrist, Payer Strategy Senior Consultant with POCP, welcome Anthony Murray, Chief Information Officer of MRO, to tackle one of health IT’s most pressing topics: payer-provider data exchange and interoperability.
The discussion begins with introductions and a light-hearted acknowledgment of the traditional friction between payers and providers. Anthony shares his journey from pharmaceutical work to leading MRO’s efforts in clinical data exchange. He emphasizes the enduring challenges in interoperability, including siloed systems and the complexities of real-time data sharing.
The conversation then shifts to the evolving patient-centric approach. Anthony and Kendra explore how technology like patient portals has improved engagement but highlight gaps in bidirectional data exchange. They dive into the payer-provider dichotomy, with Kendra explaining how payers are shifting their mindset to view data holistically as patient data rather than isolated categories like claims or provider information.
Later, the trio examines successful payer-provider collaborations, such as Anthony’s example of a client achieving a 63% improvement in quality scores through seamless digital connectivity. They also spotlight the Da Vinci Project and other initiatives driving innovation in the space.
The regulatory landscape takes center stage with a discussion of the CMS-0057 rule, which aims to streamline prior authorization and bolster interoperability. Both Anthony and Kendra share candid views on the challenges of implementing these changes and the opportunities they present for strategic advantage.
Closing on a forward-looking note, Anthony calls for active industry participation in shaping health IT’s future, urging stakeholders to engage in accelerators and public comment opportunities. Kendra envisions a healthcare system that embraces real-time digital experiences, aligning with the expectations of younger generations.
Tune in for actionable insights and spirited dialogue about the future of health IT and interoperability!
Key Themes:
- Challenges in payer-provider data exchange
- Opportunities in patient-centric interoperability
- Regulatory impacts, including CMS 0057
- Examples of successful collaborations driving innovation
- Strategic shifts in viewing data holistically
Listen now to explore how collaboration, technology, and regulation are reshaping health IT! Find us on Apple Podcasts, Spotify, and Healthcare Now Radio, or watch on the POCP YouTube channel. Don’t forget, health IT is a dish best served hot!
